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RES-SUS (Brazil EHR)National E-Health Architecture

Jussara Rötzsch, MD, MScDirector Of OpenEHR Foundation

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A Bit of History

Health Information Systems in use in the Public Sector since the 1970s Data are available on www.datasus.gov.br; DATASUS is the MoH’s Department of Informatics and provides HIT

solutions for states and cities.

Vertical applications were the initial focus More than 250 siloed systems: HIV, Prenatal and Child Care, TB, Diabetes and others;

Two major projects sparked change, around 2000 The National Health Card Project (SUS Card)

• Standards for unique IDs for individuals (including HC workers); The National Registry of HC Providers,

• Unique identifiers for HC Professionals• Relationships among procedures, HC professionals, equipment

and organizations.

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An Architecture for eHealth

Interoperability Layer: Norms, Standards and Regulations

HC FacilitiesRegistry

HC WorkersRegistries

ClientRegistry

TerminologyServer

MessagingServices

SharedEHR

Indicators

Other…

Other… NIDRegistry

System NSystem 01 System 02 System 03 System 04

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Main Goals of an Architecture

Recognize and provide answers to wide organizational needs Corporate, federal or state governments, large communities... Driven by Strategic Goals

Recognize and provide answers to local and specific needs Specialties, cities, small communities... Driven by local needs

Policies, Regulations, Norms, IT Architectures, Infrastructure, HR

• Organizational Resources

• Infrastructure• IT Architecture• Human Resources

Integration

Independence & Liberty

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Background for the Brazilian Case Brazil has a long tradition in the use of Health Information Systems; Several initiatives have been developed trying to make the SUS

systems interoperate with each other; PNIIS – the National Policy on Health Information and Health

Informatics is in its final process of construction; Expectation around use of eHealth as a significant strategy to

support SUS has increased, in a similar way to what occurs in countries like England, Canada, New Zealand, USA and Australia, among others;

A Ministerial Order was published in 2011 selecting openEHR to be the reference model to the National EHR, SNOMED CT the national health terminology and IHE profiles to be used in the exchange of demographic and Clinical Data.

Since May 2012, DATASUS has been promoting a series of workshops on EHR Systems for SUS and the country.

It was recognized that there’s a need for a National eHealth Strategy to guide all initiatives of eHealth in Brazil

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brazil EHRCNS, PEP (eSUS), RES Nacional e Barramento

UsuarioSUSImpressão

Serviços de Negócio

Persons Registry

HealthcareProvidersRegistry

Clinical Data and Events Repositories

Knowledge artefacts OpenEHR archetypes and

templatesDW

CADSUS Web Portal Cidadão

PDQ PIX

eSUS Hospitalar eSUS AB

ES Producao Farmácia

Serviços Utilitários

APIs

Registries Data and Services

Health ServicesBus

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Overview of the architecture

EHR architecture is divided in four main building blocks:

• Software: corresponde aos sistemas existentes ou a desenvolver que vão alimentar e consumir dados do RES e outros serviços;

• Services: Health service bus comprising the middleware and RBAC and security services to enable a safe comunication among the diverse clinical information services and acccess of secondary to the EHR, according with security privacy and consentment policies;

• Registry Services: Person, Health Professional and Healthcare providers registries. Used in the middlware to cross and locate the right patient information;

• Repositories:• Clinical Data Repository (EHR) – based on OpenEHR• Demografic EHR • XDS – Document Directory. Following the IHE profile. CDA R2 will be the

exchange format.

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Repositório clínico

1. Problems and diagnoses 2. Medications;3. Alergies and adverses reactions; 4. Imunizations; 5. Blood type;6. Vital signs;7. Biometric measures;8. Personal and Family antecedents;9. Habits and Risk Factors;10. Procedures;11. Lab tests;12. Image tests;13. Patient education;14. Episodes:

i. Episodes – Admission data;ii. Episodes – Reason of Encounter;iii. Episodes – Present disease story;iv. Episodes – Main diagnosis and

secondary diagnoses;v. Episodes – Discharge summary;vi. Episodes – Clinical events summary.

15. E-referral

Patient’s Clinical

Information

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Example Semantic Framework – Requested medication

Requested medication encompasses:

1. Requested and administred medications during any clinical event:

2. Prescripted medication to be taken after the clinical event.

Reference archetypes:• openEHR-EHR-INSTRUCTION.medication_order-

ubr.v1• openEHR-EHR-CLUSTER.chemical_description-ubr.v1• openEHR-EHR-CLUSTER.medication_amount.v1• openEHR-EHR-CLUSTER.timing.v1• openEHR-EHR-CLUSTER.medication_admin.v1

Arquétipo de referência:• openEHR-EHR-INSTRUCTION.medication_order.v1

• openEHR-EHR-CLUSTER.chemical_description.v1

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Example Semntic Framework – Requested medication(2)

Atribute Type Cardinality Comments

Medication DV_TEXT 1..1  Code DV_CODED_TEXT 0..1 Code according existing

terminology. TUSS (Reimbursement

Terminology)

Active principle DV_TEXT 0..* ATC???No existing

Strength per dose Unit DV_TEXT 0..1 Definição da dosagem para cada princípio ativo

Form DV _TEXT 0..1 Vocabulário controlado Anvisa

DV_TEXT 0..1 Posologia em textoDose (texto) DV_TEXT 0..1  Dose instruction DV_TEXT 0..1  

Data de início DV_DATE_TIME 0..1

Data de fim DV_DATE_TIME 0..1

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Challenges

• International archetypes were changed because Brazil lacks clinical terminologies for the most business cases. (To DV-TEXT)

• Data analysis is compromised by the lack of terminologies in Brazil.

• A National Terminology Service is being considered to cross map the administrative terminologies that are in use.

• Affiliation to IHTSDO was finally off ground because adoption to SNOMED-CT and extensions (medication) are considered value proposition

• Problem list are now coded using ICD 10 na ICPC- Plus.

• In many cases we are using the internal terminologies of international and NEHTA´s openEHR archetypes ( a single library of international archetypes woul be useful to projects that want to ADOPT openEHR methodology.

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Thank you!

Jussara M p Rötzsch, MD, MScDirectoropenEHR Foundationwww.openehr.org – jussara.macedo@openehrfoundation.org+55 21 9611 7403